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28 Cards in this Set
- Front
- Back
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What orders should you order for an in house patient for surgery?
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Labs - CBC with diff, PT/PTT/INR, sma-7
X-rays OR in AM anesthesia to see pt npo after midnight Chest x-ray, ECG (if necessary) (you might also have to call for medical clearance for the patient) |
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What is in a CBC?
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WBC, hemoglobin, hematocrit, platelets
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Normal values of CBC?
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Every lab has different lab valuses, but...
WBC: 5000 to 10,000 Hemoglobin: for males 14-18 g/dl; for females 12-16 g/dl Hematocrit: For males is 40-54%; for females 37-47% Platelets: 150,000-450,000 |
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When dealing with an infection, what do you expect to happen to the WBC count after surgery?
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Eventually is should go down, but in post-op days 1-2 the WBC may go up a point or two. This believed to be because surgery stirs up the body's reaction to the infection. It s a common occurence
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What do you do if WBC is over 10?
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First decide if the patient has an infection or not.
1. If the patient has anifection, then the antibiotics and the possible incision and drainiage should eventually decrease the WBC count. 2. If non-infected pt, then you must find out he cause. Is the pationt taking corticosteoids? is the increase acute or chronic? isther a combination of medical conditions causeing this? notify your attending/senior resident. |
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What do you do if platelets are low (under 150,000 to 350,000)
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can tranfuse plateletes, but not commonly done
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What should the hematocrit and hemoglobin be for surgery?
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Hemoglobin 10 gm/dl or greater
Hct 30% or highter |
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What is in SMA-7?
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Sodium, potassium, chloride, carbon dioxide, BUN, creatinine, glucose
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What is in SMA-12
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Sodium, potassium, chloride, carbon dioxide, BUN, creatinine, glucose, plus calcium, cholesterol, phosphatase (alkaline), transaminases (alanine and aspartate)
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What do you do if Na+ is low?
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Give NSS or regular salt.
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What should your K+ levels be?
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For K+, if pt is on digoxin worry if K+ level is around 3, if not worry if it is below 2.8. THe K+ should be below 5.2
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What do you do if K+ is too low?
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Give K rider (potassium supplement), also give potassium food in diet i.e., banana
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What do you do with elevated K+?
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1st get EKG (look for peaked T-waves)
2nd manage the hyperkalemia kayexalate calcium gluconate 10% give 10 ml over 2-5 minutes Sodium bicarbonate 7.5%, give 1 ampule IV over 5 minutes manage the glucose and insulin can use dialysis if necessary. |
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What does BUN and creatine tell you?
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Kidney function
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Which is more important - BUN or creatinine
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Creatinine is more important, because BUN is influenced by hydration state. In other words if BUN is high, but creatinine normal, then the patient is most likely dehydrated and rehydration should correct the BUN. However, if both BUN and creatinine are high then the patient most likely has kidney damage.
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What do PT/PTT/INR tell you?
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The coaguable state of pt.
If one of these is high it means that the patient will take longer to stop bleeding or it is harder for the pt to develop a blood clot. |
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What causes PTT to he high?
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heparin
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Which pathway does PTT check?
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Intrinsic
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Which pathway does PT check
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Extrinsic
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What can cause PT/INR to be high?
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Coumadin (most likely)
malnutrition alchoholism antibiotics metabolic disorders |
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What are the INR values?
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Normal = 1
Intense anticoagulation = 2-3 High intensity = 2.5 -3 |
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What do you want the INR to be for most surgeries?
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under 1.4
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What should you do if INR is over 1.4?
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Transfuse fresh frozen plasma.
Under normal circumstances, one unit of FFP should decrease the INR 0.2 however this is not a hard ruel. Vit. K is an option, but it will only bring the INR down a little and takes over 2 hours to work. |
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When is it ok to have an INR higher than 1.4 before sugery?
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1. When the risk of surgery outhweghs the risk of excessive bleeding (i.e. if it is an emergency and ansesthesia's ok'ed it)
2. With a patient with PVD and you are doing a debridement or amputation. Get Vascular Surgery's OK first |
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If you do surgery on a patient with a high INR what do you want to watch?
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The hemoglobin and hematocrit. Make sure the patient is not anemic. If the hemoglobin goes below 8 think about transfusing with prbc's
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When do you discontinue aspirin before surgery?
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7 days
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When do you discontinue coumadin before surger?
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3-5 days
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When do you discontinue heparin before surgery?
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8 hours before surgery.
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